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Introduction: Percutaneous screw fixation is a widely used treatment for posterior pelvic ring injuries. Transiliac-transsacral screw fixation has demonstrated superior biomechanical properties over bilateral sacroiliac screws, particularly in the minimally displaced bilateral sacral fractures. Screw placement under fluoroscopic control is still common, while CT navigation is gaining popularity. However, the accurate placement of screws within a safe zone is essential to avoid neurovascular complications. Methods: An anatomical study using human cadaveric pelves was conducted to assess radiological landmarks and determine a safe zone in relation to the S1 recess/foramen for transiliac-transsacral screw placement. Results: Fourteen pelves were evaluated. Ten pelves were classified as having a satisfactory corridor for screw placement, while four were deemed to have an impossible or high-risk corridor. A safe zone was defined based on the diagonal bisector of the S1 vertebral body, ICD and anterior cortex. Discussion: The study findings suggest that lateral fluoroscopic projection can determine a safe entry point for screw placement. Understanding the anatomy and landmarks on lateral fluoroscopic images is crucial for successful screw placement and avoiding complications. Conclusion: The S1 body diagonal is consistently located anterior to the S1 recess in lateral fluoroscopic projections, providing a potential safe corridor for transiliac-transsacral screw placement at the S1 level in nondysmorphic pelves. Further research is needed to confirm these findings with CT imaging and evaluate the technical feasibility of screw placement. [ABSTRACT FROM AUTHOR]

Arterial variations in the upper limb are of significant clinical importance, especially in procedures such as venepunctures, coronary artery bypass grafts, trauma reconstructive surgeries, brachial plexus nerve blocks, and breast reconstructions. This report presents previously undocumented arterial variations in the upper limbs in a 95-year-old female cadaveric donor. We observed bilateral superficial ulnar arteries originating at the cubital fossa, deviating from the previously reported origin at the proximal brachial artery. We found additional variations in the branches of the axillary artery: on the right side, two superior thoracic arteries emerged from the first part of the axillary artery, an accessory branch supplied the subscapular muscle, and the large subscapular artery arising from the third part of the axillary artery gave rise to both the lateral thoracic and posterior circumflex humeral arteries. On the left side, a common trunk was identified, giving rise to the transverse cervical, dorsal scapular, and accessory lateral thoracic and subscapular arteries. Moreover, the acromial artery originated directly from the axillary artery on both sides. This case report discusses the clinical significance of these unique vascular anatomical variants, their prevalence, and potential impact, emphasizing the importance for clinicians to be aware of such variations to enhance surgical planning and patient safety. [ABSTRACT FROM AUTHOR]

Purpose: To report the morphologic and spatial relationships of a bilateral sternalis muscle variant. Methods: Routine cadaveric dissection in an undergraduate anatomy laboratory revealed two sternalis muscles parasternal to the sternal body. Subsequent fine prosection of the anterior thoracic wall and neck was carried out to uncover the soft tissue attachments of both sternalis muscles. Positional relationship to neighboring anterior thoracic and neck structures, and geometric dimensions of the muscle bellies and tendons, were documented. Results: Both sternalis muscles were imbedded in the pectoral fascia, with their muscle fibers running obliquely to the midsternal line. The right sternalis muscle was notably larger in length, width, and thickness compared to the sternalis muscle on the left. The right sternalis muscle featured a distinct superior cord-like intermediate tendon that traversed superolateral and fused directly with the contralateral sternomastoid and sterno-occipital portions of the left sternocleidomastoid muscle. The superior tendon of the left sternalis muscle was aponeurotic and affixed to the cord-tendon of the right sternalis muscle. A distinct tendinous entheses for the sternal head for both sternocleidomastoid muscles were noted at the manubrial body. Conclusions: This case report describes a unique bilateral sternalis muscle variant with conjoined sternocleidomastoid muscle integration. This anatomical description of a sternalis-sternocleidomastoid muscle morphology may supplement radiographic interpretations and support diagnostic accuracy. [ABSTRACT FROM AUTHOR]

Abstract Arterial variations in the upper limb are of significant clinical importance, especially in procedures such as venepunctures, coronary artery bypass grafts, trauma reconstructive surgeries, brachial plexus nerve blocks, and breast reconstructions. This report presents previously undocumented arterial variations in the upper limbs in a 95-year-old female cadaveric donor. We observed bilateral superficial ulnar arteries originating at the cubital fossa, deviating from the previously reported origin at the proximal brachial artery. We found additional variations in the branches of the axillary artery: on the right side, two superior thoracic arteries emerged from the first part of the axillary artery, an accessory branch supplied the subscapular muscle, and the large subscapular artery arising from the third part of the axillary artery gave rise to both the lateral thoracic and posterior circumflex humeral arteries. On the left side, a common trunk was identified, giving rise to the transverse cervical, dorsal scapular, and accessory lateral thoracic and subscapular arteries. Moreover, the acromial artery originated directly from the axillary artery on both sides. This case report discusses the clinical significance of these unique vascular anatomical variants, their prevalence, and potential impact, emphasizing the importance for clinicians to be aware of such variations to enhance surgical planning and patient safety.

Abstract Purpose Neuroblastoma, the most common extracranial solid tumor in children under 5 years, often surrounds visceral arteries. This study aimed to analyze the working space provided by standardized surgical techniques at key arterial landmarks in adult cadavers. Methods We assessed in eight adult cadavers the mobilization of the left colon, spleen and pancreas, right colon, duodenum and mesenteric root, access to the bursa omentalis. The average working space score (AWSS) was evaluated at the left and right renal artery, left and right side of the coeliac trunk, superior mesenteric and common hepatic artery. The score was defined as: (0) vessel not visible, (1) working space at the vessel ≤ 1x diameter of the aorta, (2)

Purpose: Neuroblastoma, the most common extracranial solid tumor in children under 5 years, often surrounds visceral arteries. This study aimed to analyze the working space provided by standardized surgical techniques at key arterial landmarks in adult cadavers. Methods: We assessed in eight adult cadavers the mobilization of the left colon, spleen and pancreas, right colon, duodenum and mesenteric root, access to the bursa omentalis. The average working space score (AWSS) was evaluated at the left and right renal artery, left and right side of the coeliac trunk, superior mesenteric and common hepatic artery. The score was defined as: (0) vessel not visible, (1) working space at the vessel ≤ 1x diameter of the aorta, (2) < 3x the diameter of the aorta, (3) ≥ 3x diameter of the aorta. Results: The maximum AWSS of 3 was achieved at key vascular landmarks through specific mobilization techniques. Conclusion: Additional mobilization of spleen, pancreas and mesenteric root and access to the bursa omentalis increase surgical working space at major visceral arteries. The results of our investigation provide surgeons with a useful guide to prepare for abdominal neuroblastoma resection. [ABSTRACT FROM AUTHOR]

Purpose: While Clavicle hook plates have demonstrated favorable results regarding bone and shoulder function, their design can potentially lead to complications due to pressure concentration at the plate's tip. This study aims to investigate the impact of different hook implantation angles on the contact surface area between the hook plate and acromion, with the goal of minimizing mismatch and maximizing contact surface area. Methods: Twenty soft shoulder cadavers were included in the study, and the contact surface area of the hook plate was measured in different positions based on the hook implantation angle. Results: The results showed variations in compatibility, width, and length of the contact surface area depending on the hook implantation angle and the medial or lateral row placement. The lateral row generally demonstrated superior compatibility (84.0% vs 46.67%, p-value < 0.001), with a broader contact area (3.55 ± 0.08 mm vs 3.09 ± 0.10 mm, p-value = 0.004) and a longer contact area (7.36 ± 0.19 mm vs 5.10 ± 0.23 mm, p-value < 0.001) at specific angles. A detailed analysis of the lateral position revealed that the zero angle of implantation resulted in the greatest contact surface area, measuring 3.91 ± 0.70 mm in width (p value = 0.083) and 8.85 ± 1.24 mm in length (p value < 0.001). Conclusion: Placing the hook laterally and at the zero position according to the hook implantation angle can maximize contact surface area, may reduce stress concentration, and minimize complications in hook plate fixation. Further research and consideration of anatomical variations are warranted to refine the placement technique and enhance patient outcomes. Level of Evidence: Level V evidence. [ABSTRACT FROM AUTHOR]

Background: Hallux valgus (HV) is a complex deformity, with many associated risk factors. The flexor hallucis longus (FHL) tendon is a dynamic and potentially deforming force as it bowstrings laterally with HV. We hypothesized that FHL is more laterally inserted in the distal phalanx in cadavers with HV; therefore, it might be also a primary destabilizing force. We aim to compare the FHL distal insertion morphology and its relationship with osseous structures in cadavers with and without HV. Methods: Sixteen cadaver specimens, 8 with HV and 8 without (N-HV) were dissected. We evaluated FHL distal morphology in terms of its insertional footprint location and FHL long-axis position in relation to osseous anatomy. Results: Both the HV and N-HV groups displayed a laterally inserted footprint at the distal phalanx, with the HV group exhibiting median lateral translation of the footprint 6% greater than the N-HV group (P <.01). Both groups also demonstrated a laterally displaced position for the FHL long axis. The median FHL long axis for HV vs N-HV specimens 1 cm proximal to the IP joint was 9% more laterally displaced from the midaxis (P <.01), and at 1 cm proximal to the MTP joint was measured to be 15% more laterally displaced from the midaxis (P <.01). Conclusion: FHL demonstrated an eccentric position in terms of insertion and trajectory in both the HV and N-HV groups, with greater lateralization in specimens exhibiting HV deformity. This eccentricity potentially creates a greater deforming force vector contributing to the development of HV. Clinical Relevance: The etiology and progression of HV deformity may include a lateralized insertion of the FHL tendon. Treatment implications remain unknown at this time. [ABSTRACT FROM AUTHOR]

The infiltration of the interspace between the popliteal artery and the capsule of the posterior knee (IPACK) block, is a novel ultrasound-guided technique used for postoperative pain management of the knee. The success of the block is attributed to the spread of injectate between the capsule of the knee and the popliteal artery. This novel technique is believed to target the articular branches of the tibial, common fibular (peroneal) and obturator nerves. However, the extent of the spread in a paediatric population is unknown. Therefore, this study aims to evaluate the spread of the IPACK block. Using ultrasound guidance, the IPACK block was replicated bilaterally in neonatal cadavers. Methylene blue dye (0.3 ml/kg) was injected proximally and distally. Subsequently, cadavers were dissected to determine the injectate spread. Proximal injections resulted in staining of some of the articular branches, while the distal injections resulted in staining of all four articular branches. Additional staining of the superior lateral and medial genicular nerves was noted irrespective of the technique. Overall, both injections resulted in posterior, anterolateral spread with limited medial spread. Results from this study reveal preservation of the main nerve trunks following the proximal technique, while the distal technique displayed greater staining of the articular branches. We believe that the block can be seen as a more holistic and viable alternative to lower limb blocks for the paediatric population, as it allows for a wider spread in the posterior and medial-lateral compartments of the knee. [ABSTRACT FROM AUTHOR]

Study Design: Human Cadaveric Biomechanical Study Objectives: Lumbar Lateral Interbody Fusion (LLIF) utilizing a wide cage has been reported as having favorable biomechanical characteristics. We examine the biomechanical stability of unilateral pedicle screw and rod fixation after multilevel LLIF utilizing 26 mm wide cages compared to bilateral fixation. Methods: Eight human cadaveric specimens of L1-L5 were included. Specimens were attached to a universal testing machine (MTS 30/G). Three-dimensional specimen range of motion (ROM) was recorded using an optical motion-tracking device. Specimens were tested in 3 conditions: 1) intact, 2) L1-L5 LLIF (4 levels) with unilateral rod, 3) L1-L5 LLIF with bilateral rods. Results: From the intact condition, LLIF with unilateral rod decreased flexion-extension by 77%, lateral bending by 53%, and axial rotation by 26%. In LLIF with bilateral rods, flexion-extension decreased by 83%, lateral bending by 64%, and axial rotation by 34%. Comparing unilateral and bilateral fixation, LLIF with bilateral rods reduced ROM by a further 23% in flexion-extension, 25% in lateral bending, and 11% in axial rotation. The difference was statistically significant in flexion-extension and lateral bending (P <.005). Conclusions: Considerable decreases in ROM were observed after multilevel (4-level) LLIF utilizing 26 mm cages supplemented with both unilateral and bilateral pedicle screws and rods. The addition of bilateral fixation provides a 10-25% additional decrease in ROM. These results can inform surgeons of the incremental biomechanical benefit when considering unilateral or bilateral posterior fixation after multilevel LLIF. [ABSTRACT FROM AUTHOR]

Purpose: It is unclear which triceps tendon repair constructs and techniques produce the strongest biomechanical performance while minimizing the risk of gap formation and repair failure. We aimed to determine associations of construct and technique variables with the biomechanical strength of triceps tendon repairs. PubMed, Embase, Cochrane Library, Web of Science, Scopus, and ClinicalTrials.gov were systematically searched for peer-reviewed studies on biomechanical strength of triceps tendon repairs in human cadavers. 6 articles met the search criteria. Meta-regression was performed on the pooled dataset (123 specimens). Outcomes of interest included gap formation, failure mode, and ultimate failure load. Covariates were fixation type; number of implants; and number of sutures. Stratification by covariates was performed. We found no association between fixation type and ultimate failure load; however, suture anchor fixation was associated with less gap formation compared with transosseous direct repair (β = − 1.1; 95% confidence interval [CI]:− 2.2, − 0.04). A greater number of implants was associated with smaller gap formation (β = − 0.77; 95% CI: − 1.3, − 0.28) while a greater number of sutures was associated with higher ultimate failure load (β= 3; 95% CI: 21, 125). In human cadaveric models, the number of sutures used in triceps tendon repairs may be more important than the fixation type or number of implants for overall strength. If using a transosseous direct repair approach to repair triceps tendon tears, surgeons may choose to use more sutures in their repair in order to balance the risk of larger gap formation when compared to indirect repair techniques. Level of Evidence: Level III. [ABSTRACT FROM AUTHOR]

Introduction: The accessory appendicular artery (AAA) is an accessory source of blood supply to the appendix. Its existence and potential point of origin are seldom addressed in the literature. Methods: To fill this knowledge gap, we performed a systematic review of all available studies involving both cadaveric and surgical specimens and documented the presence and the origin of the AAA, following the guidelines outlined in the preferred reporting items for systematic reviews and meta‐analysis (PRISMA) statement. Results: Eleven studies, with an overall of 604 specimens were included. Our research revealed that the AAA is notably absent in most cases (83.6%). When present, it most commonly originates from the posterior cecal artery (12.4%), followed by the descending branch of the ileocolic artery (2%), and the ileal branch of the ileocolic artery (0.7%). Instances of origin from the anterior cecal, common cecal, or the ileocolic trunk were even more infrequent. Based on our observations, we introduced a new simplified classification system. Discussion: The effect of an accessory artery on the process of appendicitis remains to be clarified. We firmly recommend that surgeons should consider the possible presence and various origins of the AAA during appendectomy procedures to avoid serious complications. [ABSTRACT FROM AUTHOR]

Background: Treatment of ulnar collateral ligament (UCL) tears with suture tape augmentation has gained interest given preliminary reports of favorable biomechanical characteristics. No study to date has quantitatively assessed the biomechanical effects of multiple augmentation techniques relative to the native UCL. Purpose: To perform a systematic review and meta-analysis of controlled laboratory studies to assess and comparatively rank biomechanical effects of UCL repair or reconstruction with or without augmentation. Study Design: Systematic review and meta-analysis; Level of evidence, 4. Methods: PubMed, OVID/Medline, and Cochrane databases were queried in January 2023. A frequentist network meta-analytic approach was used to perform mixed-treatment comparisons of UCL repair and reconstruction techniques with and without augmentation, with the native UCL as the reference condition. Pooled treatment estimates were quantified under the random-effects assumption. Competing treatments were ranked in the network meta-analysis by using point estimates and standard errors to calculate P scores (greater P score indicates superiority of treatment for given outcome). Results: Ten studies involving 206 elbow specimens in which a distal UCL tear was simulated were included. UCL reconstruction with suture tape augmentation (AugRecon) restored load to failure to a statistically noninferior magnitude (mean difference [MD], –1.99 N·m; 95% CI, –10.2 to 6.2 N·m; P =.63) compared with the native UCL. UCL reconstruction (Recon) (MD, –12.7 N·m; P <.001) and UCL repair with suture tape augmentation (AugRepair) (MD, –14.8 N·m; P <.001) were both statistically inferior to the native UCL. The AugRecon condition conferred greater load to failure compared with Recon (P <.001) and AugRepair (P =.002) conditions. AugRecon conferred greater torsional stiffness relative to all other conditions and was not statistically different from the native UCL (MD, 0.32 N·m/deg; 95% CI, –0.30 to 0.95 N·m/deg; P =.31). Medial ulnohumeral gapping was not statistically different for the AugRepair (MD, 0.30 mm; 95% CI, –1.22 to 1.82 mm; P =.70), AugRecon (MD, 0.57 mm; 95% CI, –0.70 to 1.84 mm; P =.38), or Recon (MD, 1.02 mm; 95% CI, –0.02 to 2.05 mm; P =.055) conditions compared with the native UCL. P-score analysis indicated that AugRecon was the most effective treatment for increasing ultimate load to failure and torsional stiffness, whereas AugRepair was the most effective for minimizing medial gapping. Conclusion: AugRecon restored load to failure and torsional stiffness most similar to the parameters of the native UCL, whereas Recon and AugRepair did not restore the same advantageous properties at time zero. Medial ulnohumeral gapping during a valgus load was minimized by all 3 treatments. Based on network interactions, AugRecon was the superior treatment approach for restoring important biomechanical features of the UCL at time zero that are jeopardized during a complete distal tear. [ABSTRACT FROM AUTHOR]

Agenesis of the left hepatic lobe is a rare anomaly described as the absence of liver tissue on the left side of the gallbladder fossa or falciform ligament. Here we report a case of agenesis of the left hepatic lobe identified during educational dissection of an 84-year-old male formalin-fixed cadaver. The gross anatomical characteristics, embryological origin, and clinical relevance of this rare variation are described in this report. [ABSTRACT FROM AUTHOR]

An analytical method for studying DNA degradation by electrophoresis after cell lysis and visualization of DNA fragments with fluorescent dye, comet assay, was used to evaluate the viability of the endothelial layer of human arterial grafts with the aim of identifying the procedure that will least damage the tissue before cryopreservation. Four groups of samples were studied: cryopreserved arterial grafts that were thawed in two different ways, slowly lasting 2 hours or rapidly for approx. 7 minutes. Arterial grafts that were collected as part of multiorgan procurement with minimal warm ischemia time. Cadaveric grafts were taken as part of the autopsy, so they have a more extended period of warm ischemia. The HeadDNA (%) parameter and others commonly used parameters like TailDNA (%). TailMoment, TailLength, OliveMoment, TailMoment to characterize the comet were used to assess viability in this study. The ratio of nondecayed to decayed nuclei was determined from the values found. This ratio for cadaveric grafts was 0.63, for slowly thawed cryopreserved grafts 2.9, for rapidly thawed cryopreserved grafts 1.9, and for multi-organ procurement grafts 0.68. The results of the study confirmed the assumption that the allografts obtained from cadaveric donors are the least suitable. On the other hand, grafts obtained from multiorgan donors are better in terms of viability monitored by comet assay. [ABSTRACT FROM AUTHOR]

Surgical approach to head and neck region requires in depth anatomical knowledge and refined surgical skills due to highly critical and complex anatomy of this region. To look for the benefit of cadaveric hands-on workshop on enhancing the surgical knowledge and confidence of the participants. Freshly frozen cadavers were used for this hands-on course in the department of Anatomy, AIIMS Raipur involving 32 residents and ENT specialists. This course involved the interactive lectures and live surgical demonstration on issues related to neck dissection, thyroid, and parotid surgery followed by a hands-on practice by the residents. A positive feedback was given by the participants in regards to the cadaveric hands-on workshop. Almost 4/5th of the participants found the present experience to be extremely helpful and all of them believed the cadaveric hands-on workshops should be conducted regularly as a learning tool and enhancement of surgical skills. Cadaveric hands-on dissection is a very effective practice for refining surgical skills. It can be used to study basic surgical procedures or extremely complex surgeries having intricate anatomy. [ABSTRACT FROM AUTHOR]

Calcaneal osteotomies correct hindfoot deformities and are often performed using a minimally invasive technique. The aim was to compare the safety of three calcaneal osteotomy techniques (oblique, chevron with apex anterior and chevron with apex posterior). Each osteotomy technique was performed on five cadavers (n = 15). These were then dissected to identify any injury to the neurovascular bundles. The distance between the burr and these structures was measured. Using the apex posterior technique, the burr was closer to the medial and lateral neurovascular structures, and in one case the sural nerve was injured. There were no neurovascular injuries using the other techniques. Minimally invasive surgery using a burr is generally a safe, reliable method for performing calcaneal osteotomies. The chevron with apex posterior osteotomy should be performed with caution given the closer relationship between the burr and neurovascular bundles. The other two techniques provide safer alternatives. 4 [ABSTRACT FROM AUTHOR]

The superficial temporal artery (STA) is one of the most encountered vessels in neurosurgery and has a significant importance in cerebral bypass surgery. In cerebral bypass surgery, a suitable donor vessel to create the bypass graft close to the recipient artery with suitable size, is essential. The STA can be harvested easily and is readily accessible, minimizing surgical complexity. Using the STA as the donor artery has shown to have lower rates of complications compared to other graft options. It has a low risk of spasm and thrombosis, which could lead to graft failure. Additionally, harvesting the STA does not cause significant damage to surrounding tissues, reducing the risk of postoperative complications. The STA has a robust and consistent blood flow, making it an ideal candidate for grafting during cerebral bypass surgery. Understanding the variations of the STA is important to surgeons who encounter it during an operation. In this cadaveric study, we obtained length and internal elastic lamina diameter measurements of the STA trunk and its branches. Our cadaveric internal elastic lamina diameters were consistent with the literature's as well as the STA trunk and frontal branch lengths but the parietal branch length measurements were significantly different from the related literature's. Further cadaveric studies of the STA must be conducted as a better understanding the anatomy of this vessel by cerebrovascular surgeons. [ABSTRACT FROM AUTHOR]

Understanding the clinical anatomy of the head is essential for performing proper inferior alveolar nerve (IAN) block anesthesia to facilitate invasive dental procedures in camels. However, osteometric data related to the IAN in camels are lacking. This study was carried out to accurately locate the mandibular foramen (MF) and the course of the IAN in the camel head and to establish an approach for its localization in clinical practice. To achieve these aims, eight osteometric measurements were used to determine the location of the MF in relation to its surrounding structures in six cadaveric skulls of adult camels. Four camel heads were dissected, and the course of the IAN inside the mandibular canal was studied. In addition, four heads were used as a trial for the extraoral approach to the IAN block using contrast radiographs based on established metric indices. Dissection of the four camel heads revealed that the MF was located near the intersection of two lines passing through the occlusal surface of the mandibular cheek teeth and at the midpoint of the zygomatic process of the temporal bone. Significant differences were not observed between the right and left mandibles. Successful deposition of the contrast medium near the MF was observed in all examined specimens. This study reports a new, simple approach to reaching the IAN at the MF. However, further clinical validation of the proposed technique is required. [ABSTRACT FROM AUTHOR]

Background: Biodegradable subacromial balloon spacers (SBSs) have become increasingly used for the treatment of massive irreparable rotator cuff tears given their theorized clinical benefits; however, the relationship between biomechanical functions of the balloon spacer and clinical benefits remains unclear. Purpose: To perform a systematic review and meta-analysis of controlled laboratory studies investigating the use of SBSs for massive irreparable rotator cuff tears. Study Design: Systematic review and meta-analysis; Level of evidence, 4. Methods: PubMed, OVID/Medline, and Cochrane databases were queried in July 2022 for biomechanical data pertaining to SBS implantation in cadaveric models of irreparable rotator cuff tears. Random-effects meta-analysis of continuous outcomes using the DerSimonian-Laird method was performed to estimate pooled-treatment effect sizes between the irreparable rotator cuff tear state and the state in which an SBS was implanted. Data reported variably or in formats not amenable to analysis were presented descriptively. Results: Five studies involving 44 cadaveric specimens were included. At 0° of shoulder abduction, SBS implantation resulted in a mean inferior humeral head translation of 4.80 mm (95% CI, 3.20-6.40; P <.001) relative to the irreparable rotator cuff tear state. This decreased to 4.39 mm and 4.35 mm at 30° and 60° of abduction, respectively. At 0° of abduction, implantation of an SBS was associated with a 5.01-mm (95% CI, 3.56-6.46, P <.001) anterior translation of the glenohumeral center of contact pressure relative to the irreparable tear state. This translation changed to 5.11 mm and 5.49 mm at 30° and 60° of abduction. In 2 studies, SBS implantation restored the glenohumeral contact pressure to that of the intact state and significantly reduced subacromial pressure distribution over a rotator cuff repair state. In 1 study, a high balloon fill volume (40 mL) resulted in a significant 10.3 ± 1.4–mm more anterior humeral head position relative to the intact cuff state. Conclusion: SBS implantation in cadaveric models of irreparable rotator cuff tears results in significant improvements in humeral head position at 0°, 30°, and 60° of shoulder abduction. Balloon spacers may also improve glenohumeral and subacromial contact pressures, although insufficient evidence currently exists to corroborate these findings. High balloon fill volumes (40 mL) may confer supraphysiologic anteroinferior translation of the humeral head. [ABSTRACT FROM AUTHOR]

Background: Kidney transplantation gives the best quality of life to chronic kidney disease patients and also increases longevity. Aim: Analysis of factors responsible for the early and delayed graft functioning in live and cadaver renal transplants Methods: It was a retrospective observational study. Donor and recipient age, sex, BMI, comorbid illness, and functioning status of the donor kidney, duration and severity of chronic kidney disease and associated bladder disorders were collected. Operative factors like perfusion time, cold ischemia time, blood pressure fall, need for blood transfusion, vasopressor support was recorded. Patients were divided into two groups based on early versus delayed graft function. Results: 27 cases of Live donor renal transplant and 23 cadaver transplants were included. The average age in live donor and cadaveric transplants was 43.5 ±7.6 years and 38.3 ±10.5 years, respectively. 24 Live Transplant Recipients had Early Graft function (89%). Seven Cadaveric Transplant Recipients had Early Graft function (31%) and 16 of them had Delayed Graft Function (69%). HLA Mismatch, Perioperative Hypotension and BMI of recipient had statistically significant relationship to Early Graft Function with p values of 0.02, 0.004 and 0.007, respectively. With p-value of 0.021 and of 0.046, respectively, perioperative hypotension and cold ischemic time in Cadaveric renal transplantation had statistically significant relationship to Early Graft Function. Conclusion: Live donor transplants have better early graft function. HLA Mismatch, Perioperative Hypotension, BMI of recipient and cold ischemic time in Cadaveric renal transplantation are the predictors of early graft function. Keywords Cadaveric,, ,،,؛Kidney transplantation,, ,،,؛

Understanding the clinical anatomy of the head is essential for performing proper inferior alveolar nerve (IAN) block anesthesia to facilitate invasive dental procedures in camels. However, osteometric data related to the IAN in camels are lacking. This study was carried out to accurately locate the mandibular foramen (MF) and the course of the IAN in the camel head and to establish an approach for its localization in clinical practice. To achieve these aims, eight osteometric measurements were used to determine the location of the MF in relation to its surrounding structures in six cadaveric skulls of adult camels. Four camel heads were dissected, and the course of the IAN inside the mandibular canal was studied. In addition, four heads were used as a trial for the extraoral approach to the IAN block using contrast radiographs based on established metric indices. Dissection of the four camel heads revealed that the MF was located near the intersection of two lines passing through the occlusal surface of the mandibular cheek teeth and at the midpoint of the zygomatic process of the temporal bone. Significant differences were not observed between the right and left mandibles. Successful deposition of the contrast medium near the MF was observed in all examined specimens. This study reports a new, simple approach to reaching the IAN at the MF. However, further clinical validation of the proposed technique is required.

The extratemporal course of the facial nerve distributes in facial mimic muscles in a complex pattern. The traditional depictions of five main branches without anastomoses are not common. Davis classification remains the gold standard in the classification of facial nerve branching patterns. During a routine dissection of an 74-year-old male cadaveric specimen, we detected a very rare anatomical variation. The zygomatic branch of the facial nerve was totally absent. The temporofacial division of the main trunk was bifurcated to a temporal and a buccal branch. The anterior temporal and posterior buccal branches formed a plexus to supply the orbicularis oculi muscle. This unique variability highlights the complexity of the extratemporal facial nerve course. Retrograde facial nerve dissection requires deep knowledge of every anatomical variation of the facial nerve course to avoid an iatrogenic injury. [ABSTRACT FROM AUTHOR]

Introduction: Ultrasonography allows high-resolution visualisation of the peripheral nerves for quantitative and qualitative analyses. We report cross-sectional area values (quantitative measure) and echo intensity values (qualitative measure) for 46 peripheral nerve sites in upper and lower extremities in cadaveric specimens. Objective: To determine cross-sectional area values and echo intensity values of peripheral nerves of upper and lower extremities at 46 nerve sites. Methods: Nerve measurements were obtained using electronic callipers and ultrasonography for linear dimension and cross-sectional area measurements, respectively, in six cadaveric specimens for 46 peripheral nerve sites. Ultrasound images were further analysed to estimate echo intensity percentage values for 46 nerves. Results: We present normal cross-sectional area values of various nerves of upper and lower extremities with their respective echo intensity values. Calculated cross-sectional area values from linear dimensions did not match the measured cross-sectional area values via trace method. Conclusion: Cross-sectional area values (quantitative measure) and echo intensity values (qualitative measure) for 46 peripheral nerve sites in upper and lower extremities in cadaveric specimens are presented. The estimation of cross-sectional area via linear measurement is not a good approximation of the cross-sectional area (cross-sectional area measured by trace method on ultrasound image). [ABSTRACT FROM AUTHOR]

Introduction: Variations in the duct system of the pancreas lead to anomalies that predispose to diseases like acute or chronic pancreatitis or impairment of the pancreatic exocrine function. Pancreas divisum is the most common ductal anomaly leading to chronic pancreatitis. Objectives: This study was aimed at observing, understanding, and analyzing recorded variations of the ductal anatomy of the pancreas with the purpose of reviewing the literature on pancreatic duct anatomy, and underlining its importance in daily invasive endoscopic and surgical practice. Methods: A total of 10 cadaveric pancreas and duodenum were obtained en bloc from the abdomen. Following the injection of eosin dye for better visualization of the ducts, piecemeal dissection of the parenchyma of the gland was carried out to expose the duct system of the pancreas. A total of 10 outpatient department (OPD) cases of pancreatitis from the department of radiology in whom MRCP had been performed were chosen at random. The findings were interpreted, tabulated, compared with outcomes of previous studies, and analyzed. Result: Our findings from the cross-sectional observational study suggest that out of twenty pancreas, 75% of cases showed the presence of major pancreatic ducts, and 25% of cases showed the presence of both main and accessory pancreatic ducts. MRCPs of patients with acute/chronic pancreatitis obtained from the Department of Radiology showed the presence of a single duct, suggesting that presence of single duct anatomy might be a predisposing condition for the occurrence of pancreatitis. Conclusion: This knowledge is significant for planning diagnostic procedures and procedure-related complications. Magnetic resonance cholangiopancreatography (MRCP) is the investigation of choice for visualizing the pancreatic and biliary ductal anatomy as it is noninvasive and safe. Hence, based upon findings of the pancreatic ductal system using cadaveric pancreas and MRCP, associations between the patterns and anomalies with pancreaticobiliary diseases were assessed.

A very rare anatomical variation of external jugular vein's penetration by the transverse cutaneous nerve of the neck is displayed in the current study. The phenomenon of veins' fenestration or penetration by other structures, such as nerves along with its likely embryologic development are discussed. Moreover, the potential clinical significance of that variation's awareness on behalf the physician is discussed in detail. [ABSTRACT FROM AUTHOR]

Background: In Saudi Arabia, the gap between the demand for and availability of organs persists, with a total of 13,731 patients on the waiting list in 2019. Family refusal is a major obstacle limiting donation since their consent must be obtained prior to the retrieval of organs. The cause of family refusal is mainly due to their lack of knowledge of their loved ones' wish to become a donor. This paper aimed to compare three systems of obtaining consent in terms of effectiveness, respect for autonomy, and the cultural role of families in Saudi Arabia to ensure feasibility and effectiveness in increasing the number of donors. Policy alternatives and implications: The consent systems include informed consent, presumed consent, and mandated choice. The mandated choice policy might be the optimal solution since it is the most likely to balance the respect for individual autonomy and the cultural role of families in Saudi Arabia. Conclusions and recommendations: Mandated choice ensures the respect of autonomy while influencing the next of kin's decision to donate the organs. Additionally, a recommendation to decision makers is to utilize the Tawakkalna app to send alerts to the next of kin when a user registers as a donor with the users' consent. Moreover, more research should be dedicated to investigating the Saudi public's current culture and perceptions towards organ donation to ensure feasibility.

Human small intestinal crypts are the source of intestinal stem cells (ISCs) that are capable of undergoing self-renewal and differentiation to an epithelial layer. The development of methods to expand the ISCs has provided opportunities to model human intestinal epithelial disorders. Human crypt samples are usually obtained from either endoscopic or discarded surgical samples, and are thereby exposed to warm ischemia, which may impair their in vitro growth as three-dimensional culture as spheroids or enteroids. In this study we compared duodenal samples obtained from discarded surgical samples to those isolated from whole-body preserved cadaveric donors to generate in vitro cultures. We also examined the effect of storage solution (phosphate-buffered saline or University of Wisconsin [UW] solution) as well as multiple storage times on crypt isolation and growth in culture. We found that intestinal crypts were successfully isolated from cadaveric tissue stored for up to 144 h post-procurement and also were able to generate enteroids and spheroids in certain media conditions. Surgical samples stored in UW after procurement were sufficiently viable up to 24 h and also allowed the generation of enteroids and spheroids. We conclude that surgical samples stored for up to 24 h post-procurement in UW solution allowed for delayed crypt isolation and viable in vitro cultures. Furthermore, in situ, hypothermic preservation in cadaveric duodenal samples permitted crypt/ISC isolation, and successful culture of spheroids and enteroids from tissues held for up to 6 days post-procurement.

Introduction: The brachial plexus is a network of nerves originating in the periclavicular region and provides sensory and motor innervation to the upper extremity. The plexus is an important structure due to its anatomical location and vulnerability to damage. As such, surgeons need to be able to locate individual plexus segments or nerve branches when performing procedures. However, finding the sites of uniting and dividing points within the brachial plexus can prove challenging. Methods: Dissections were performed bilaterally on 30 formalin-fixed adult cadavers to expose the individual segments and branches of the brachial plexus. Subsequently, various measurements were taken. Measurements included the length of the roots, trunks, divisions, cords, and terminal branches (musculocutaneous, median, ulnar, radial, and axillary nerves). Results: The statistical test revealed the Mean±SD length of the middle and inferior trunk was 34.75±29.6 mm and 39.8±14.2 mm respectively. The Mean±SD of lateral cord was 47.75±14.98 mm, the posterior cord 45±13.20 mm, and the medial cord was 48.75±16.44 mm. The terminal branches were as follows: Musculocutaneous nerve 67±25.03 mm, median nerve 206.20±116 mm, ulnar nerve 219.70±29.70 mm, radial nerve 117.30±17 mm and axillary nerve 65.60±13.30 mm. Conclusion: A thorough understanding of all relevant anatomical landmarks is mandatory for any successful procedure. Common techniques, such as brachial plexus blocks, require detailed anatomical literature due to the complexity and variability of the plexus. Results from this study will add to the understanding of the anatomy of the brachial plexus and further assist clinicians in pre- and perioperative surgical planning.

Rare facial nerve branching patterns, pose dangers due to their unexpected course. Cases with multiple branches may reduce the intraoperative risk, due to the compensation of adjacent branches. We present a case of a cadaveric specimen where an early trifurcation of the mandibular branch of the facial nerve was noted. [ABSTRACT FROM AUTHOR]

Background- The heart receives its nutrition through the coronary arteries. They are the right and left coronary arteries. Coronary arteries are located in the epicardium which finally penetrate into the myocardium. Aim and Objectives: To Observe the coronary artery dominance in human cadaveric hearts. Material & Methods: The study was carried out on 120 human cadaveric hearts from the Department of Anatomy, IMC&H Indore (M.P.), AFMS&RC Faridabad (Haryana), DYSPGMC Nahan (HP). Result: Present study we observed that the right dominance in 89.16% specimens and left dominance in 8.33% specimens. Balanced dominance was also observed in 2.5% specimens. Conclusion: The data of the present study will be helpful for interpretation of coronary angiography and surgical myocardial revascularisation [ABSTRACT FROM AUTHOR]

Purpose: Robotic total knee arthroplasty (TKA) has seen a rapid increase in utilization with recent literature suggesting that implant accuracy and resection are better optimized than in conventional TKA. The purpose of this study was to evaluate the biomechanical properties of robotic-assisted versus conventional TKA in minimizing biplanar femoral and tibial resection error in cadaveric specimens. Methods: A systematic review and meta-analysis was performed by searching through PubMed, Cochrane library, and Embase to identify studies that analyzed the biomechanical properties of robotic assisted and conventional TKA, according to standard PRISMA guidelines. Evaluated outcomes included femoral coronal resection error (deg), femoral sagittal resection error (deg), tibial coronal resection error (deg), and tibial sagittal resection error (deg). Results: Seven studies met inclusion criteria, including a total of 140 cadaveric specimens (robotic: 70, conventional: 70), for resection accuracy between robotic and conventional TKA. Pooled analysis from seven studies revealed a significant difference in femoral coronal and sagittal resection error in favor of robotic systems compared to conventional systems (p < 0.001 & p < 0.001, respectively). The pooled analysis from seven studies revealed a significant difference in tibial sagittal resection error in favor of robotic systems compared to conventional systems following TKA (p = 0.012). Posthoc power analysis revealed a power of 87.2%. Conclusion: The use of robotic TKA is associated with lower femoral coronal, lower femoral sagittal and tibial sagittal resection error compared to conventional TKA. It should be noted that these findings are purely biomechanical – surgeons should interpret these findings along with clinical differences between conventional and robotic systems to determine which system is best for each patient. [ABSTRACT FROM AUTHOR]

Objective: This article aims to discuss the surgical nuances and major adjustments necessary in unlocking the frontotemporal dural fold (FTDF) and extradural anterior clinoidectomy (EDAC) in actual cases, allowing translation from the cadaveric to a clinical scenario. Materials and Methods: We retrospectively reviewed the technical details of 17 procedures over 8 years, where both the initial steps (FTDF unlocking and EDAC) were performed. Lesions involving or extending to the anterolateral skull base, like the suprasellar cistern, optico‑carotid cistern, interpeduncular cistern, petrous apex, and cavernous sinus, were included. The clinical data of the patients were retrieved retrospectively from the hospital information system (HIS) and in‑patient records. This study was approved as a multicenter individual project with IEC No: 2020‑342‑IP‑EXP‑34. Results: An illustrated note of the common steps and outcome of the 17 procedures of unlocking the FTDF and EDAC done is presented. The technique provided adequate exposure in performing aneurysmal clipping (posterior communicating artery [P. com], basilar top, and superior hypophyseal artery [SHA] aneurysm), giant pituitary adenoma (Wilson Hardy grade 4E, n = 2), fifth nerve schwannoma (n = 4), right Meckel’s cave melanoma, cavernous hemangioma (n = 4), petroclival meningioma (n = 2), and clival chordoma. Temporary and permanent cranial nerve palsy as a procedure‑related complication was seen in 11.8% (n = 2) each. Complete excision was achieved in 13 (n = 13/14) patients with tumors. Conclusion: FTDF unlocking and EDAC are elegant procedures providing reasonable access to the anterolateral skull base for myriad pathologies. Brain bulge, cavernous sinus bleeding, and losing the plane of dural duplication were significant challenges in switching from cadaveric to a clinical scenario. [ABSTRACT FROM AUTHOR]

Synthetic bone models have increasing utility in orthopaedic research due to their low cost and low variability and have been shown to be biomechanically equivalent to human bones in a variety of ways. The rise in additive manufacturing (AM) for orthopaedic applications presents an opportunity to construct synthetic whole-bone models for biomechanical testing applications, but there is a lack of research comparing these AM models to cadaveric or commercially available bone surrogates. This study compares the mechanical properties of 3D printed clavicle models to commercially available (4th generation Sawbones) and human cadaveric clavicles via nondestructive cyclic 4-point bending, axial compression, and torsion, and a final axial compression test to failure. Commercially available synthetic clavicles had 57.8–203% higher superior-inferior bending rigidity (p < 0.0001), 80.9–198% higher axial stiffness (p < 0.001), and 314–557% higher torsional rigidity (p < 0.05) on average than AM and cadaveric clavicles. Cadaveric and AM clavicles printed from a BoneMatrix/VeroWhite composite material had similar failure mechanisms under axial compression while AM VeroWhite clavicles experienced catastrophic failure, but these groups did not have significantly different ultimate failure loads. Together, these results demonstrate that current commercially available synthetic clavicles may be too rigid to emulate the mechanical properties of elderly cadaveric clavicles, and that AM bone models can closely mimic these cadaveric bones in a variety of biomechanical loading schemes. These results show promising applications for future work using 3D printed bone surrogates for biomechanical analysis of orthopaedic implants and other surgical repair techniques. [ABSTRACT FROM AUTHOR]

Background: To achieve an optimal clinical outcome in reverse total shoulder arthroplasty (RSA), accurate placement of the components is essential. The recently introduced navigation technology of augmented reality (AR) through head-mounted displays (HMD) offers a promising new approach to visualize the anatomy and navigate component positioning in various orthopedic surgeries. We hypothesized that AR through HMD is feasible, reliable, and accurate for guidewire placement in RSA baseplate positioning. Methods: Twelve human cadaver shoulders were scanned with computed tomography (CT) and RSA baseplate positioning was 3-D planned using dedicated software. The shoulders were prepared through a deltopectoral approach and an augmented reality hologram was superimposed using the HMD Microsoft HoloLense. The central guidewire was then navigated through the HMD to achieve the planned entry point and trajectory. Postoperatively, the shoulders were CT-scanned a second time and the deviation from the planning was calculated. Results: The mean deviation of the entry point was 3.5 mm ± 1.7 mm (95% CI 2.4 mm; 4.6 mm). The mean deviation of the planned trajectory was 3.8° ± 1.7° (95% CI 2.6°; 4.9°). Conclusion: Augmented reality seems feasible and reliable for baseplate guidewire positioning in reverse total shoulder arthroplasty. The achieved values were accurate. [ABSTRACT FROM AUTHOR]

Introduction: Core decompression supplemented by stem cell incorporation is an upcoming field of research in avascular necrosis of the femoral head. Plugging the canal to avoid loss of the concentrate injected has been recognized as a crucial step to improve the efficacy of the procedure. We describe a new surgical technique that results in native bone plug formation and eliminates the need for any additional blocker. Methodology: This pilot study was performed on 4 cadaveric proximal femurs. The standard technique was used for core decompression and bone marrow aspirate concentrate (BMAC) injection. Additionally, two more tracts were drilled, superolateral, and inferomedial to the primary tract. Results: No leakage of the radiopaque dye was observed from the entry point of the primary tract, ensuring its complete blockage in all 4 cadaveric proximal femurs. This was confirmed by sectioning the femur specimens which manifested bone plug formation at the confluence of the three tracts. Conclusion: Our technique is a unique and economical method of preventing leakage of BMAC through the entry point in the proximal femoral metaphysis. This may not only benefit patients but can also provide the groundwork for further research in this field. [ABSTRACT FROM AUTHOR]

Introduction: Percutaneous screw fixation is a widely used treatment for posterior pelvic ring injuries. Transiliac-transsacral screw fixation has demonstrated superior biomechanical properties over bilateral sacroiliac screws, particularly in the minimally displaced bilateral sacral fractures. Screw placement under fluoroscopic control is still common, while CT navigation is gaining popularity. However, the accurate placement of screws within a safe zone is essential to avoid neurovascular complications., Methods: An anatomical study using human cadaveric pelves was conducted to assess radiological landmarks and determine a safe zone in relation to the S1 recess/foramen for transiliac-transsacral screw placement., Results: Fourteen pelves were evaluated. Ten pelves were classified as having a satisfactory corridor for screw placement, while four were deemed to have an impossible or high-risk corridor. A safe zone was defined based on the diagonal bisector of the S1 vertebral body, ICD and anterior cortex., Discussion: The study findings suggest that lateral fluoroscopic projection can determine a safe entry point for screw placement. Understanding the anatomy and landmarks on lateral fluoroscopic images is crucial for successful screw placement and avoiding complications., Conclusion: The S1 body diagonal is consistently located anterior to the S1 recess in lateral fluoroscopic projections, providing a potential safe corridor for transiliac-transsacral screw placement at the S1 level in nondysmorphic pelves. Further research is needed to confirm these findings with CT imaging and evaluate the technical feasibility of screw placement., Competing Interests: Declarations. Competing interests: The author(s) declare that they have no competing interests., (© 2024. The Author(s).)

The posterior malleolus of the tibia is commonly accessed surgically through the posterolateral approach. This approach gives good access to the fibula and lateral aspect of the posterior tibia, however; there is little known on the vascular risks with this approach. The aim of this study was to assess and describe the anatomy of the fibular artery and its branches at the ankle region and relate it to the surgical access of the posterior malleolus. Eleven cadaveric foot and ankle specimens were dissected in layers, preserving the fibular artery, anterior tibial artery (ATA), and posterior tibial artery (PTA). Five distinct variations were found in the fibular artery: variable terminal branching with a hyperplastic fibular artery; a superficially located fibular artery; variation in the level and number of anastomoses; variation in the muscular branches; and a variable anterior perforating branch. The mean proximal distance from a horizontal line drawn through the medial protuberance of the medial malleolus of the tibia (horizontal line reference point-HLRP) to the posterior communicating branch of the fibular artery was 37.93 mm (range 19.03-85.43 mm). The mean proximal distance between HLRP and the anterior perforating branch of the fibular artery was 44.23 mm (range 35.44-62.32 mm). In 10 specimens, the fibular artery was immobile distal to its anterior perforating branch. The posterolateral approach specifically puts the fibular artery at risk and knowledge of its anatomy and variability is important when undertaking this approach. Understanding the common variations within the ankle's arterial anatomy can help surgeons protect these vessels from damage during the surgical approach., (© 2023 The Authors. Clinical Anatomy published by Wiley Periodicals LLC on behalf of American Association of Clinical Anatomists and British Association of Clinical Anatomists.)

Abstract Purpose Robotic total knee arthroplasty (TKA) has seen a rapid increase in utilization with recent literature suggesting that implant accuracy and resection are better optimized than in conventional TKA. The purpose of this study was to evaluate the biomechanical properties of robotic‐assisted versus conventional TKA in minimizing biplanar femoral and tibial resection error in cadaveric specimens. Methods A systematic review and meta‐analysis was performed by searching through PubMed, Cochrane library, and Embase to identify studies that analyzed the biomechanical properties of robotic assisted and conventional TKA, according to standard PRISMA guidelines. Evaluated outcomes included femoral coronal resection error (deg), femoral sagittal resection error (deg), tibial coronal resection error (deg), and tibial sagittal resection error (deg). Results Seven studies met inclusion criteria, including a total of 140 cadaveric specimens (robotic: 70, conventional: 70), for resection accuracy between robotic and conventional TKA. Pooled analysis from seven studies revealed a significant difference in femoral coronal and sagittal resection error in favor of robotic systems compared to conventional systems (p

Background: In Saudi Arabia, the gap between the demand and availability of organs persists, with a total of 13,731 patients who remain on the waiting list in 2019. Family refusal is a major obstacle limiting donation since their consent must be obtained prior to the retrieval of organs. The cause of family refusal is mainly due to the unknown wishes of their loved one to become a donor. This analysis aimed to compare three systems of obtaining consent in terms of effectiveness, respect for personal autonomy, and the cultural role of families in Saudi Arabia to ensure feasibility and effectiveness in increasing the number of donors. Policy alternatives and implications: The consent systems include opt-in (explicit consent), opt-out (presumed consent), and mandated choice systems. The mandated choice policy might be the optimal solution to investigate since it could balance the respect for individual autonomy and the cultural role of families in Saudi Arabia. Conclusions and recommendations: Mandated choice ensures the respect of personal autonomy while influencing the next of kin's decision to donate the organs. Additionally, a recommendation to decision makers is to utilize the Tawakkalna app to send alerts to the next of kin when a user registers as a donor with the user's consent. Moreover, more research should be dedicated to investigating the Saudi public's current culture and perceptions of organ donation to ensure feasibility.

Background: Injuries to posterolateral corner (PLC) of knee are often neglected. The three key components of PLC are lateral collateral ligament (LCL), popliteofibular ligament (PFL) and popliteus tendon (PT). For adequate reconstruction, anatomic location of these ligaments should be well understood. Material and methods: Twenty formalin fixed cadaveric knees were dissected. PT and LCL identified. Circumference of the two structures marked with pen just after cutting them close to bone surface. Distance between the centre of LCL and PT was measured along with the measurement of distal femoral medio-lateral dimension (MLD) and Anteroposterior dimension (ALD) of lateral condyle. Result: The mean distance between PT and LCL measured in 20 specimens was 8.3 ± 0.84 mm, with a range of 7 mm to 10 mm. MLD was 81.0 ± 3.6 mm and APD was 62.7 ± 3.2 mm. Conclusion: The distance in Indian population is significantly smaller compared to the western. This has clinical implication in drilling the tunnels for PLC reconstruction. [ABSTRACT FROM AUTHOR]

Background: The objectives of the study were to evaluate the structures at risk in distal metatarsal mini-invasive osteotomy (DMMO) and to compare standard and intraosseous approaches.Methods: DMMO was performed on the second and fourth metatarsals of 11 fresh-frozen cadaveric specimens. The standard technique was performed in 11 metatarsals. It was then compared to a modified intraosseous technique that entails starting inside the bone in 11 other metatarsals. The cadavers were dissected to identify unintentional injury to soft tissue structures.Results: In the standard group the most injured structures were the metatarsal joint capsules (MJC) (27%), extensor digitorum longus (EDL) (18%), and extensor digitorum brevis (EDB) (9%). The modified intraosseous group injured the EDL (27%), not the MJC (0%) and the EDB (0%). Distances between osteotomies and the dorsal metatarsal head articular surface (DMHAS) were 6.08 ± 3.99 mm in the standard and 9.92 ± 3.42 mm in the modified (p = 0.02).Conclusion: The DMMO techniques most frequently injured the EDL. Intra-articular positioning of the osteotomy was more observed in the standard. Overall, it appears the modified method could be an alternative to the standard DMMO.Clinical Relevance: The modified minimally invasive DMMO has a comparable rate of potential iatrogenic injuries. This intraosseous procedure may present as an option when planning surgery to the lesser metatarsals.Level Of Evidence: Level III. Comparative Cadaveric Study. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate the anatomical features of the lateral collateral complex (LCC) of the elbow in a Thai population. We dissected 56 cadaveric elbows and described the LCC three-dimensionally in sagittal and coronal planes. We found that the characteristics differed from previous reports in other ethnic populations. In the sagittal plane, the centre of the origin of the LCC was located 3 mm anteriorly and 4 mm inferiorly to the apex of the lateral humerus epicondyle, and in the coronal plane it was 4 mm deep. The vertical distance between the origin of the lateral ulnar collateral ligament (LUCL) and the lateral epicondyle and the distance from the LUCL insertion to the border of the ulnar bone differed significantly between sexes. These data may be useful for surgeons during reconstruction of injures to the LCC of the elbow. Level of evidence: V [ABSTRACT FROM AUTHOR]

Purpose: Traditional tension band fixation of patella fracture is associated with high reoperation rates. The purpose of the study was to assess strength of fixation in patella fractures treated with either a non-metallic all suture-based technique or traditional metallic tension band wiring.Methods: Ten paired human cadaveric specimens were included. A transverse fracture was created, reduced and fixated with a non-metallic or metallic approach. Non-metallic fixation was done according to a previously published technique, metallic fixation was done according to AO description. Specimens were fixed in 90° of flexion and underwent 200 cycles of loading by pulling the Quadriceps tendon to 300 Newton. Fracture displacement was optically monitored. Primary outcome was fracture displacement after 200 cycles compared to the first cycle. Subsequently, load-to-failure was assessed by a monotonic pull to 1000 N.Results: For cyclic loading analysis, one specimen from each group was excluded due to machine synchronization, resulting in a total population of 18 specimens. Median (min-max) fracture displacement was 0.65 mm (0.06-1.3) in the non-metallic group and 0.68 mm (0-1.23), (p=0.931) in the metallic group. No difference in displacement was found between the two groups in the repeated measures analysis of variance (p=0.5524). For load-to-failure analysis one specimen was excluded due to machine synchronization, resulting a total population of 19 specimens. 2/9 specimens failed in the non-metallic group (at 979 and 635 N) and 2/10 failed in the metallic group (745 and 654 N).Conclusion: Non-metallic technique is a biomechanically viable alternative to traditional tension band fixation and it can hopefully lead to fewer implant-related complications. [ABSTRACT FROM AUTHOR]

Abstract Background Failure of surgical fixation in orthopaedic fractures occurs at a significantly higher rate in osteoporotic patients due to weakened osteoporotic bone. A therapy to acutely improve the mechanical properties of bone during fracture repair would have profound clinical impact. A previous study has demonstrated an increase in mechanical properties of acellular cortical canine bone after immersion in raloxifene. The goal of this study was to determine if similar treatment yields the same results in cancellous fetal bovine bone and whether this translates into a difference in screw pull-out strength in human cadaveric tissue. Methods Cancellous bone from fetal bovine distal femora underwent quasi-static four-point bending tests after being immersed in either raloxifene (20 μM) or phosphate-buffered saline as a control for 7 days (n = 10). Separately, 5 matched pairs of human osteoporotic cadaveric humeral heads underwent the same procedure. Five 3.5 mm unicortical cancellous screws were then inserted at standard surgical fixation locations to a depth of 30 mm and quasi-static screw pull-out tests were performed. Results In the four-point bending tests, there were no significant differences between the raloxifene and control groups for any of the mechanical properties - including stiffness (p = 0.333) and toughness (p = 0.546). In the screw pull-out tests, the raloxifene soaked samples and control samples had pullout strengths of 122 ± 74.3 N and 89.5 ± 63.8 N, respectively. Conclusions Results from this study indicate that cancellous fetal bovine samples did not demonstrate an increase in toughness with raloxifene treatment, which is in contrast to previously published data that studied canine cortical bone. In vivo experiments are likely required to determine whether raloxifene will improve implant fixation.

Introduction: The brachial plexus is a network of nerves originating in the periclavicular region and provides sensory and motor innervation to the upper extremity. The plexus is an important structure due to its anatomical location and vulnerability to damage. As such, surgeons need to be able to locate individual plexus segments or nerve branches when performing procedures. However, finding the sites of uniting and dividing points within the brachial plexus can prove challenging. Methods: Dissections were performed bilaterally on 30 formalin-fixed adult cadavers to expose the individual segments and branches of the brachial plexus. Subsequently, various measurements were taken. Measurements included the length of the roots, trunks, divisions, cords, and terminal branches (musculocutaneous, median, ulnar, radial, and axillary nerves). Results: The statistical test revealed the Mean±SD length of the middle and inferior trunk was 34.75±29.6 mm and 39.8±14.2 mm respectively. The Mean±SD of lateral cord was 47.75±14.98 mm, the posterior cord 45±13.20 mm, and the medial cord was 48.75±16.44 mm. The terminal branches were as follows: Musculocutaneous nerve 67±25.03 mm, median nerve 206.20±116 mm, ulnar nerve 219.70±29.70 mm, radial nerve 117.30±17 mm and axillary nerve 65.60±13.30 mm. Conclusion: A thorough understanding of all relevant anatomical landmarks is mandatory for any successful procedure. Common techniques, such as brachial plexus blocks, require detailed anatomical literature due to the complexity and variability of the plexus. Results from this study will add to the understanding of the anatomy of the brachial plexus and further assist clinicians in pre- and perioperative surgical planning. [ABSTRACT FROM AUTHOR]

Arterial tortuosity describes variation via bending of the arterial wall and has been noted in several arteries throughout the body. Tortuous blood vessels can cause nerve compression, as well as present difficulties to surgeons and radiologists. Here we present an unusual case of multi-vessel arterial tortuosity discovered in 78-year-old Hispanic male cadaver, independent of systemic pathology. The left ulnar and right tibial arteries were dissected, and using calibrated digital callipers, their external and internal diameters were measured both at the origin site and at the site of greatest dilation. Both wall thickness and the number of inflection points were also measured. Six bends were noticed in the ulnar artery and its diameter measured 8.11 mm at its widest, with a wall thickness of 0.88 mm. On the lower extremity, the right tibial artery had three bends and its diameter measured 4.86 mm at its widest, with a wall thickness of 1.32 mm. This uncommon tortuosity is not only more prone to laceration during surgery, but the bending and thickening can be mistaken for tumours. Finally, fluid dynamics can be altered, resulting in an impact on blood pressure in the extremities. Thus, raising awareness is crucial to prevent both symptoms and iatrogenic complications. [ABSTRACT FROM AUTHOR]

Introduction: Patients often suffer from an elongated styloid process. This clinical entity is well known and is described as Eagle syndrome. The presence of this anatomical variation is not always associated with symptoms. However, there is a strong correlation between the elongated styloid process and Eagle syndrome. Aim: This study aims to calculate the incidence of elongated styloid processes in the Greek population, to analyze the morphometric characteristics of styloid processes, and to compare these among sexes. Material and methods: This is a single-center retrospective study. All skulls were donated to the Department of Anatomy, the Aristotle University of Thessaloniki from January 2013 to May 2019 for research purposes. A styloid process longer than 30 mm was considered elongated. We used Welch’s t-test for the statistical analysis of the data. Results: The prevalence of elongated styloid processes was 35%. The average diameter was 3.32 mm and the average total length was 25.02 mm. There was no statistically significant difference between male and female skulls, though the female styloid processes were slightly longer and the male ones were slightly wider. Symmetry was recorded in 31% of skulls. Average axial angle was 650 but in 4% of cases it was less than 200 . Conclusions: The elongated styloid process is not a rare entity. Eagle syndrome should always be considered in the differential diagnosis when patients report chronic sore throat. Our anatomical findings add a new dimension to the etiopathogenesis of Eagle syndrome. [ABSTRACT FROM AUTHOR]